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11724 Ventura Blvd., Suite A // Studio City, CA 91604
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Sayana Medical and Wellness Center
Functional Medicine – Studio City, California
Studio City, CA
1-818-331-4386
Call us:
1-001-234-5678
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Home
About
About
Team
Patient Forms
Services
Primary Care
Internal, Functional and Naturopathic Medicine
Integrative Pediatric Care
Integrative Pediatrics Medical Care for Children (Ages 7 Up).
Myofascial Therapy
Targets points within your tissues called “trigger points.”
Acupuncture & FSM
Relieve pain, increase blood flow and oxygen to muscles
Nutritional and Lifestyle Therapy
Nutrition plans tailored for your specific needs.
IV Therapy
Nutrients straight into your bloodstream for instant results
DISCOVER ALL OUR SERVICES
Team
Appointments
Store
Blood Health
Cardiometabolic Health
Detox
Fatigue
Gastrointestinal Health
General Wellness
Hormone Balance
Immune Health
Metabolic Detoxification
Neurological Health
Skin Health
Stress Management
ON SALE
WHAT’S NEW
COVID Update
Insurance & Pricing
Contact
Home
About
About
Team
Patient Forms
Services
Primary Care
Internal, Functional and Naturopathic Medicine
Integrative Pediatric Care
Integrative Pediatrics Medical Care for Children (Ages 7 Up).
Myofascial Therapy
Targets points within your tissues called “trigger points.”
Acupuncture & FSM
Relieve pain, increase blood flow and oxygen to muscles
Nutritional and Lifestyle Therapy
Nutrition plans tailored for your specific needs.
IV Therapy
Nutrients straight into your bloodstream for instant results
DISCOVER ALL OUR SERVICES
Team
Appointments
Store
Blood Health
Cardiometabolic Health
Detox
Fatigue
Gastrointestinal Health
General Wellness
Hormone Balance
Immune Health
Metabolic Detoxification
Neurological Health
Skin Health
Stress Management
ON SALE
WHAT’S NEW
COVID Update
Insurance & Pricing
Contact
Note: Your Results will be displayed after Submission.
The Patient Health Questionnaire (PHQ-9)
Name
*
First
Last
Email
*
Date of Visit
*
Date Format: MM slash DD slash YYYY
Phone
*
The Patient Health Questionnaire (PHQ-9)
Over the last 2 weeks, how often have you been bothered by the following problems?
Little interest or pleasure in doing things
*
Not at all
Several Days
Half the Days
Nearly Every Day
Feeling down, depressed or hopeless
*
Not at all
Several Days
Half the Days
Nearly Every Day
Trouble falling asleep, staying asleep, or sleeping too much
*
Not at all
Several Days
Half the Days
Nearly Every Day
Feeling tired or having little energy
*
Not at all
Several Days
Half the Days
Nearly Every Day
Poor appetite or overeating
*
Not at all
Several Days
Half the Days
Nearly Every Day
Feeling bad about yourself - or that you're a failure or have let yourself or your family down
*
Not at all
Several Days
Half the Days
Nearly Every Day
Trouble concentrating on things, such as reading the newspaper or watching television
*
Not at all
Several Days
Half the Days
Nearly Every Day
Moving or speaking so slowly that other people could have noticed. Or, the opposite - being so fidgety or restless that you have been moving around a lot more than usual
*
Not at all
Several Days
Half the Days
Nearly Every Day
Moving or speaking so slowly that other people could have noticed. Or, the opposite - being so fidgety or restless that you have been moving around a lot more than usual
*
Not at all
Several Days
Half the Days
Nearly Every Day
Thoughts that you would be better off dead or of hurting yourself in some way
*
Not at all
Several Days
Half the Days
Nearly Every Day
If you checked off any problems, how difficult have those problems made it for you to Do your work, take care of things at home, or get along with other people?
*
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
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